胃腫瘍性病変の拡大内視鏡診断―陥凹型上皮性腫瘍

Observations of Depressed Type Early Gastric Cancer Using Narrow Band Imaging with Magnifying Endoscopy

要旨　粘膜内胃癌167病変を対象に，NBI併用拡大内視鏡像の検討を行った．腺窩辺縁上皮の形態により微細表面構造は7つ，血管の口径と形状・連結の形態により微小血管構造からは6つの特徴が抽出された．典型的な陥凹型胃癌のNBIME像は微細表面構造の破壊・消失・小型を示す領域において微小血管像の変化を伴うものであった．組織型を推測するできる所見として小型の微細表面構造およびcorkscrew型，ちりちり型，fine network型の微小血管構造が抽出できたが，一部の症例に適応されるものであった．現状では，通常・色素観察に加えた補助的なものとしてNBIMEを使用するのが妥当と考える．

　The characteristics of microsurface and microvascular patterns of intramucosal EGC（early gastric cancer）observed by NBIME（narrow band imaging with magnifying endoscopy）were extracted. According to the morphology of marginal crypt epithelium, there were seven patterns of microsurface structure. There were six patterns of microvascular patterns according to vessel size, shape and connections. The typical pattern of depressed type EGC was a combination of destructed, disappeared or small microsurface with various caliber microvessels. To distinguish the histological type of EGC, small type microsurface and corkscrew type, frizzled type, fine network type of microvascular pattern were specific patterns, but the number of cases with these features were limited. At present, it is reasonable to use NBIME as a supplementary diagnostic tool to normal endoscopy with chromoendoscopy.